The percentage of patients who leave the emergency department without being seen by a provider is a measure of efficiency and presents risk-management concerns. The number of patients actually “seen” by a provider is a measure of productivity. The opening of our new emergency department in December 2012, resulted in increases in both demand and the percentage of patients who left without being seen. Operational nursing leadership managed ED patient flow, but the structure was loosely organized on an ad hoc basis.
Operational nursing leadership roles were re-assigned to personnel with management aptitude and interest. The charge nurse coordinated care throughout all sections (pods) of the department while the pod lead nurse coordinated care in each pod. The flow coordinator nurse accepted transfers and emergency medical services arrivals. Nursing and physician staffing remained unchanged, and measures were calculated over a 3-year period (December 3, 2012, to December 2, 2015). The number of patients seen per day was analyzed using simple linear regression. The percentage of patients who left without being seen was analyzed using fractional logistic regression; P< 0.05 was considered statistically significant.
The weekly mean number of patients seen per day rose 13% from 265 to 299 patients. The weekly mean percentage of patients who left without being seen declined 45% from 8.2% to 4.5%. The regression lines for both measures were significant at P < 0.001.
Measures of efficiency and productivity can be improved significantly with a dedicated operational nursing leadership structure without adding nursing or physician staffing.
Contribution to Emergency Nursing Practice
- •In the emergency department, the number of patients seen per day is a measure of productivity.
- •The percentage of patients who leave without being seen is a measure of efficiency.
- •Dedicated nursing management structure can improve productivity in the emergency department and the efficiency of flow.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Nursing
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- A conceptual model of emergency department crowding..Ann Emerg Med. 2003; 42: 173-180
- Improving patient flow and reducing emergency department crowding: a guide for hospitals: Content reviewed October 2014.Accessed November 11, 2016)
- More patients, less payment: increasing hospital efficiency in the aftermath of health reform.Health Aff. 2011; 30: 76-80
- Emergency Nurses Association position statement: crowding in the emergency department.J Emerg Nurs. 2006; 32: 42-47
- The relationship between emergency department crowding and patient outcomes: a systematic review.J Nurs Scholarsh. 2014; 46: 106-115
- Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit.Crit Care Med. 2007; 35: 1477-1483
- Increase in patient mortality at 10 days associated with emergency department overcrowding.Med J Aust. 2006; 184: 213-216
- Improvement in emergency department length of stay using a nurse-led “emergency journey coordinator”: A before/after study.Emerg Med Australas. 2014; 26: 158-163
- ED conical redesign, team-based care and improvements in hospital performance: a time-series analysis.Emerg Med Australas. 2015; 27: 317-322
- Time and expenses associated with the implementation of strategies to reduce emergency department crowding.J Emerg Nurs. 2012; 38: 420-428
- Improving ED time to provider a, left-without treatment rates and average length of stay.J Emerg Med. 2014; 45: 426-432
- An integrative review: triage protocols and the effect on emergency department length of stay.J Emerg Nurs. 2013; 39: 398-408
- The role of triage nurse ordering on mitigating overcrowding in emergency departments: a systematic review.Acad Emerg Med. 2011; 18: 1349-1357
- Advanced nursing interventions and length of stay in the emergency department.J Emerg Nurs. 2013; 39: 221-225
- Key requirements for a new era of emergency department operations research.Ann Emerg Med. 2011; 57: 101-103
Niels K. Rathlev is Chair, Department of Emergency Medicine, Baystate Medical Center, Springfield MA
Jacqualyn Anderson, Member, Pioneer Valley ENA, is Director, Emergency Department, Baystate Medical Center, Springfield, MA.
Joseph Schmidt is Vice Chair, Emergency Department, Baystate Medical Center, Springfield, MA.
Joeli Hettler is Chief of Pediatric Emergency Medicine, Baystate Medical Center, Springfield, MA.
Lynn Garreffi, President, Pioneer Valley ENA Chapter, is Associate Director, Baystate Medical Center, Springfield, MA.
Molly Gray is Vice President, Baystate Medical Center, Springfield, MA.
Douglas Neal is Vice President, Baystate Medical Center, Springfield, MA.
Paul Visintainer is Vice-President for Academic Affairs, Baystate Medical Center, Springfield, MA.
Published online: December 07, 2017
Earn Up To 7.0 Hours. See page 218.
© 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.